Cancer Prevention, Screening and Treatment: Performance

Premature Mortality
Three-year average mortality rates for cancer (ages under 75) for England have fallen for each period since the baseline, from 141.2 deaths per 100,000 population in 1995-97 to 114.0 deaths per 100,000 population in 2006-08, and are now 19.3% below the baseline rate. If the trend of the last ten years were to continue, the target would be met. Three-year average mortality rates for cancer (ages under 75) for Lewisham have also fallen for each period since the baseline from 154.4 per 100,000 population to 127.2 per 100,000. The absolute gap in mortality rates between England and Lewisham is unchanged from baseline to 2006-08 and remains at 13.2 per 100,000. Over the same period, the relative gap – i.e. percentage difference – in mortality rates between England and Lewisham has increased from 9.3% in 1995-97 to 11.6% in 2006-08). However Lewisham’s premature mortality rates for cancer are lower than those of the Spearhead Group as a whole. In 2006-08 the relative gap for the Spearhead Group as a whole was 16.3% compared to the Lewisham gap of 11.6%.

One year survival rates
One-year survival rates are generally accepted as a good proxy for early/late diagnosis. The National Cancer Intelligence Network has developed benchmarks of good performance on one-year survival rates for the four commonest cancers, based on the EUROCARE-4 findings for patients diagnosed in 1995–99. “Average” is based on the average one-year survival rate for Europe in 1995–99. “Good practice” is based on the average achieved across a whole country by the best performing countries in EUROCARE-4. As can be seen from Table 6, the range of one-year survival performances observed for cancer networks in England in 1999–2001 fell below the consensus benchmark on all four major cancers (i.e. no single network achieved “good practice”). For colon and lung cancers, no single network achieved even the European average. This shows the major scope for improvement. Performance at individual PCT level is shown in Table 7.

Table 6: Consensus benchmarks for one-year survival rates for the four commonest cancers 

  1. EUROCARE-4: age-adjusted one-year relative survival rates, adults diagnosed 1995–99.
  2. “Good practice” is based on the highest one-year survival rates of countries with 100% cancer registration in EUROCARE-4, rounded down to the nearest whole number. For all four tumour types, Sweden was among the highest in Europe.
  3. The cancer network range is based on patients diagnosed in 1991–2001 (from the National Centre for Health Outcomes Development).

Table 7: Lewisham PCT one year survival rates for Breast, Colon and Lung cancer


National Cancer Screening Programmes

Breast Screening
The NHS Breast Screening programme provides free breast screening every three years for all women aged 50 and over. The programme is extending the age range of women eligible for screening to ages 47-73 by 2012. The indicator used in the breast screening programme is coverage. Coverage is defined as the proportion of eligible women that has had a test with a recorded result at least once in the previous 3 years. Currently coverage is best assessed using the 53-64 age groups as women may be invited for screening at any time between their 50th and 53rd birthdays. The national coverage target is 70%. The national coverage rate has increased by nearly 3% (from 74.9% to 77%) between 2003-04 and 2008-09. Coverage in Lewisham in 2008-09 was (65.7%), just above London (65.1%) but below the England (77%) average. Coverage varies considerably by GP practice in Lewisham, in 2008-09 there were: - 1 (2%) out of 49 practices had a coverage of 70%. - 6 (12%) practices with coverage of between 65% and 69%. The lowest coverage was one practice at 35%.

Cervical Cancer Screening
The NHS cervical screening programme is population-based programme and offers screening to women between the ages of 25 to 64 years. All women aged 25-49 years are screened on a three yearly basis and women between the ages of 50 and 64 years are screened every five years. The effectiveness of the cervical screening programme is judged by its coverage. Coverage is defined as the percentage of eligible women between the ages of 25 and 64 years who have had an adequate test result in the last five years. The target for five-year coverage is 80% .The national coverage rate dropped from 80.6% to 78.6% between 2003-04 to 2008-09. In Lewisham the coverage rates has dropped in the same period from 75.5% to 74.5% in 2008.09. Coverage varies considerably by GP practice, in 2008-09 there were:

  • 5 (10%) out of 49 practices achieved coverage of 80%.
  • 19 (38%) practices with coverage of between 75% and 79%.
  • One practice had the lowest coverage of 55%.

Bowel Cancer
The national bowel cancer screening programme was introduced in England in 2006. It offers screening every two years to all men and women aged 60-69. People over 70 can request a screening kit. The programme is to be extended to include people aged up to 75. In Lewisham it is expected the extension will start in 2010. The national target for bowel screening is 60% uptake. At a national level the uptake at end of December 2009 was 53%, for London 40.26%. In Lewisham the programme was launched in January 2008. Since that time there have been nearly twenty thousand invites sent out, 7,820 kits return, resulting in an uptake of 39.24%.There have been sixteen bowel cancers detected in Lewisham patients since the inception of the programme.

South East London Cancer Network (SELCN)
The NHS Cancer Plan (2000) requires the SELCN to agree, implement and monitor local plans to improve the outcomes of cancer treatment, as evidenced by increasing compliance with NICE Improving Outcomes Guidance (IOG) and the associated national cancer standards. The section below summarises the SELCN progress to date and proposed action to implement the published guidance to improve outcomes in Haematological cancers (Oct 2003) and Palliative and Supportive Care (March 2004), Head and Neck cancers (Nov 2004), Children and Young People with Cancer (August 2005), skin including melanoma (Feb 2006), Sarcoma (March 2006) and Brain (June 2006).

Haematological Cancers
The NCAT has now indicated that the Network meets the IOG although this will need to be validated through peer review. Staffing ratios in all Trusts remains an issue to achieve peer review requirements.

Head & Neck Cancer
The Network has established the new community based support team, which became operational in September 2009.The Network is now fully compliant with this IOG.

Children and Young People with Cancer (C&YP)
Good Progress is being made with the implementation of the IOG.

Skin Cancer
Skin services have been peer reviewed and Trusts and the network are producing action plans to ensure compliance with the IOG and to meet peer review requirements. Brain and Central Nervous System The National Cancer Action have tasked each MDT to update MDT activity and workforce against the IOG for submission by the February 2010

Supportive and Palliative Care
A final Stock take is currently being undertaken for submission to NCAT by March 2010. The Cancer Action Team along with an SHA lead will be visiting networks in 2010 to offer further support. The Network along with the majority of other networks will be red lighted on psychological care and rehabilitation where further work and investment is still needed.






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